CIPFA Conference 2013 “Moving beyond the status quo”

1. CIPFA Conference 2013“Moving beyond the status quo” “Keeping well? Governance in a complex environment” Hugh Mc Caughey Chief Executive, South Eastern HSC Trust 22nd November 2013

2. CIPFA Conference 2013“Moving beyond the status quo” “Keeping well? Governance in a complex environment” Or How do we know what we are doing is Safe + up to Standard

3. “Health care is complicated, and, even when the staff and clinicians are doing their very best (which is most of the time), errors occur and problems arise for patients that no one intends” “The only conceivably worthy honour due to those harmed is to make changes that will save other people and other places from similar harm” Don Berwick, former President & CEO of the Institute for Healthcare Improvement

4. The International Safety context “To err is human”+ “Organisation with a Memory” USA – 100,000 lives IHI + Health Foundation Wales 5000 lives NICE + SCIE Quality 2020 in NI

5. Avoidable Deaths

6. So how do we know it is SAFEFrancis, Mid Staffs, Colchester… “Mid Staffs is a Trust that lost its way. It lost its focus on what it was there to do: to keep patients safe”. Sir Stephen Moss, Chair of Mid Staffs, 2009

7. Mid Staffs – the Causes • Focus on finance and targets • Tolerance of poor standards • Denial of and failure to recognise concerns (incl Users) • Trust culture of self promotion, rather than critical analysis and openness • Professional disengagement • Lack of Compassion culture

8. Striving to meet targets must not have a detrimental impact on overall care of patients Kieran Donnelly, Comptroller & Auditor General

9. Performance Management More can be gained and more lives saved through the development of the science of performance in clinical care, than any development in genome or laboratory techniques Atul Gawande “Better”

10. SQE in SET Some Questions to ask • How can you prove your service is safe? • What is your teams objective? • What is success to you + your team? • Can you evidence you learn lessons? • What do users think – is it valued? • What Outcome(s) are you achieving? Can you answer those questions?

11. Safety in SET Some Questions to ask • your service is safe - SAFETY • your teams objective QUALITY • success to your team + • What do the people think EXPERIENCE • What are the implications if you cant?

12. SET Approach - SQE Our Goal...for every service: Assure its SAFE Improve the QUALITY Test the EXPERIENCE

13. Qlikview Dashboard

14. SQE in SET FALLS in Nursing Homes- 25% reduction Nursing KPIs

15. SQE in SET What do we want: All not some services Assurance what we do is safe Outcomes + Evidence based A Learning + Improvement Culture Users at the heart “Bottom up Culture of Safety + Improvement”

16. SQE in SE Trust It reaches the parts other systems don’t reach!

18. Bottom up Performance

19. SUCCESS

20. Nuffield report on Ratings • We conclude that the overall approach to ratings should allow complex organisations to be assessed at different levels and to promote service-specific ratings where possible; • We suggest that any rating should include measures of safety, effectiveness and user experience Rating providers for quality: a policy worth pursuing? A report for the Secretary of State for Health: summary March 2013, Nuffield Trust

21. How do we evidence safety?

22. How do we Monitor Past Harm? Corporate measures • Mortality statistics • Statutory functions • HCAIs/ Infection Rates • Falls/Pressure Ulcers • Governance system • Lessons Learnt • Service Level Assurance What do you use? How effective is change?

23. Recent Tweet “Public can accept mistakes but when it is the same mistakes, we are getting tired of that” Julie Bailey , @curetheNHS

24. Are our systems are Reliable? SET Evidence • Unallocated cases • WHO Theatre Checklist • Hand Hygiene • Mandatory Training • SQE -Adherence to Standards • Nursing KPIs • Maternity Dashboard • SQE Projects eg AKI checklist; Tracheostomy “box” Is it comprehensive?

25. SQE Projects The Future is here, it just isn't everywhere

27. Sensitivity of operations?(Alertness + Safety Awareness) SET EVIDENCE • Risk Assessments • Leadership Walkrounds • Safety Alert system + huddles • Safnctuary model • Early Warning scores • Clinical Champions • Ward Handovers • Team Morale + Leadership What do you use?

28. Do we anticipate problems + risk? SET Evidence • Risk Registers • SQE Programme • Activity Modeling • Risk Assessments eg MH • MDT Safety Brief eg ED/Obs • Lessons Learnt • Culture How are we avoiding future harm?

29. How well are we Learning? SET EVIDENCE • Case Reviews + Audit • SQE Dashboards • Patient Stories • Lessons Learnt eg Newsletter • Accountability Meetings • Qlikview Dashboards • Global Trigger tool • SQE Programme Do we learn everywhere? Does it change practice?

30. “A culture of learning can produce a safer and better NHS. The likelihood of such a culture thriving in the NHS depends, more than on anything else, on how you, the senior leaders, behave, speak and invest” “You are stewards of a globally important treasure: the NHS” Don Berwick, former President & CEO of the Institute for Healthcare Improvement

31. Checklist; How to get things right AtulGawande Medicine (H+SC) has become the art of managing extreme complexity. Failure of Ignorance we can forgive...But if the knowledge exists + is not applied correctly, it is difficult not to be infuriated

32. Finally…Learning for wider Public Sector • Don’t just chase the target • Need system of assurance + good Governance • ALSO…Need good Systems • Look forward , not just back • Bottom up….staff will own + engage • Culture important, Culture v important “It is a truism that organisation culture is informed by the nature of its leadership”.

33. THANK YOU